MEDICARE: DR. ROBERT KEITH TWILLMAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP-789	KS
2	103T00000X	Psychologist	2019030582	MO

General Provider Information

NPI Number	:	1740847755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT KEITH TWILLMAN PHD

Provider Business Mailing Address
First Line	:	13124 W 83RD TER
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66215-2824
Country	:	US
Telephone Number	:	913-205-3746
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 BALTIMORE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2304
Country	:	US
Telephone Number	:	816-932-1711
Fax Number	:	816-932-1719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	08/09/2019

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